title: Credentialing based on surgical volume, physician workforce challenges, and patient access.
abstract: Advances within the medical profession have resulted in an increase in available medical therapeutic options and minimally invasive surgical techniques for common gynecologic conditions. In many circumstances, this has led to a reduction in surgical volume for many common conditions in benign gynecology. There is also some evidence that a threshold number of cases may exist, below which surgical competence may be affected. Although the practice of medicine continues to evolve, there is broad recognition of a projected workforce shortage of physicians. If credentialing or privileging bodies establish criteria based solely on the number of procedures performed by an individual physician, patient access may be greatly affected. From a public health perspective, these issues cannot be considered in isolation. Thoughtful analysis of existing data and recognition of patient access issues should be carefully weighed before any dramatic changes in hospital privileging or hiring practices. Consideration for ongoing maintenance of credentialing should be carefully balanced and strategies for ongoing assurance of competency may require creative alternatives to simple numerical documentation. Differential approaches to regions with different densities of physicians may also be necessary.
authors.affiliation: Massachusetts General Hospital, Boston, Massachusetts; and Women's Health Services, Office of Patient Care Services/Veteran Health Administration.
authors.forename: Erin E
authors.initials: EE
authors.lastname: Tracy
authors.forename: Laurie C
authors.initials: LC
authors.lastname: Zephyrin
authors.forename: David A
authors.initials: DA
authors.lastname: Rosman
authors.forename: Lori R
authors.initials: LR
authors.lastname: Berkowitz
mesh_terms: D002983:Clinical Competence / Q000592:standards; D003406:Credentialing / Q000592:standards*; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000592:standards / Q000706:statistics & numerical data*; D006297:Health Services Accessibility; D006801:Humans; D008297:Male; D010820:Physicians / Q000600:supply & distribution*